HIV/STD transmission in gold-mining areas of Bolívar State, Venezuela: interventions for diagnosis, treatment, and prevention.

The gold-mining areas of Bolívar State in Venezuela are characterized by social, economic, and cultural factors that may facilitate transmission of HIV and other sexually transmitted diseases (HIV/STDs). For instance, gold-mining sites tend to have high concentrations of men between the ages of 20 and 45. They serve as a magnet for female commercial sex workers (FCSWs), especially if education and employment opportunities for girls and women are limited. High rates of STDs have been found among FCSWs in the gold-mining areas of Bolívar State, possibly indicative of the lack of power these sex workers have to enforce safe sexual practices with their clients (1–3). Various publications on the gold-mining areas in Bolívar State have mentioned a sharp rise in violence and alcohol and drug abuse (4), which are directly linked to the practice of unsafe sex. In such a context, transmission of HIV/STDs is more likely (3, 5, 6). There are reasons to believe that gold-mining sites may also be characterized by what is called " situational bisexual and/or homosexual behavior. " Many men never settle down, migrating out of a particular community once all the gold there has been extracted. These mining sites have their own social organization, with a private system of law and order. These are predominantly male societies, with few women present. Same-sex contacts between men are likely to occur, with a high probability of anal intercourse, which, even with the use of a condom, increases the risk of HIV/STD transmission (1, 3). The incidence of STDs among indigenous populations in gold-mining areas of Bolívar State is on the rise. There is sexual interaction among members of different Indian communities, between mine workers and female members of Indian communities , and between FCSWs and Indian males. Containing the spread of STDs and preventing HIV infection in these populations is hindered by several factors. Besides the overall social, economic, and cultural context, native populations also struggle with a lack of knowledge and understanding of sex-uality and sexual behavior; language problems; and limited access to health care facilities and health care workers in the dominant, Creole culture (3, 5 ,7). In addition, the budget for HIV/STD detection and prevention in gold-mining areas is limited or nonexistent due to the presence of other infectious